Traumatic Brain Injuries (TBI) | a beginner's primer
Disclaimer – this guide is meant for general-informational purposes only. If you have suffered a head injury – please rely on your doctor, who will be familiar with your unique circumstances, to educate you on your injury, recovery time, expected symptoms, etc…
Anytime the head is struck, there is thepotentialfor a traumatic brain injury or TBI. Remember – a "traumatic brain injury" does not necessarily refer to what some of us generally think of when such a harsh-sounding phrase is used. There are varying levels of TBI - from mild to the extremely severe. Every head injury is unique and symptoms/recovery process/maximum recovery will vary with each individual based on a multitude of factors. In the United States a combination of car accidents, firearms, and slip and falls constitute over 80% of traumatic-brain injuries.
Head Injury Severity
As a general rule. The amount of time a person is unconscious will correlate to (i) the severity of the injury (the longer the injured person is out, the worse the injury) and (ii) the length of time it will take for that person to eventually recover. In addition, as the severity of one’s injury scales up the spectrum, the more likely it is that he/she will recover with permanent deficits of varying degrees.
Being unconsious for less than an hour will generally correlate to a mild TBI (usually a concussion) – luckily, most people with head injuries have the mild form – where a complete recovery is usually expected. A minority of mild TBI patients will experience permanent symptoms (with depression, irritability and anxiety being the most common).
- If unconscious for less than a day, the head injury will usually be moderate.
- If unconscious for more than a day is usually classified as a severe Traumatic Brain Injury.
A more detailed analysis will commonly involve, among other tests, the Glasgow Coma Scale, which measures one’s level of consciousness based on verbal, motor and eye movement reactions to stimuli.
Can the brain heal after being damaged?
Luckily the brain is protected by shock-absorbing liquid within the confines of the skull. The skull itself will absorb much of any impact – just like a helmet. If the head is hit hard enough, the brain will bounce back and forth causing bruising. Like any other bruise, these will generally heal with time. But the impact or resulting swelling will sometimes cause nerve fibers with in the brain to stretch and break.
The brain also has blood vessels. A strong-enough strike to the head will cause them to burst and bleed. In less severe impacts, the bleeding will often heal on its own (like any other cut).
The rate of recovery will be quickest within the first six months after a head injury. Recovery will continue, albeit at a slower pace, after the first year. As a general rule, when sustaining a severe TBI, a patient stops recovering after two years. That is, after two years, the patient is unlikely to experience any further improvement.
- Anecdotally, I can tell you that I have a client who is challenging this theory by demonstrating further progress after the two year mark. The client attributes the continued improvement of his subjective symptoms to his aerobic workout routine that began with a few minutes a day on an exercise bike that gradually increased to two or more hours per day (the theory being that more oxygen to the brain helps in the recovery process), but this is only an anecdote and is not generally or universally accepted by the neuropsychological/medical community.
Prior head injuries is also factors in the recovery process. Having sustained a prior traumatic brain injury will tend to lead to more severe-than-expected consequences and longer recovery times when there is a subsequent head injury. The brain seems to remain in a more fragile state after recovering from the initial injury.
Age is another factor in the recovery process. Being over the age of 40 will generally lead to slower recovery times and less chance for a full recovery.
Potential Symptoms after Traumatic Brain Injury
The most common symptoms, experienced by those who sustain head injuries, are together known as Post-Concussive Symdrome – most common after mild traumatic brain injuries. Post concussive syndrome symptoms may be realized days or weeks after a TBI. Some symptoms are simply a side-effect of the healing process (like an itchy scab) that return to normal after the healing process has run its course. Other symptoms may subside somewhat, but never fully heal. This, of course, depends on the severity of the head injury. Symptoms of post-concussive syndrome are:
- Diminished Ability to Focus
- Memory Issues
- Increased Irritability
- tinnitis (ringing in the ears)
- Double or Blurry vision
- Sensitivity to Bright Light
- Sluggishness – More easily worn out
- feeling of being easily overwhelmed
These are all symptoms that everyone experiences from time-to-time without a brain injury. Sometimes it can be initially difficult to differentiate between someone who really is experiencing an increase in frequency, intensity and/or duration of the above symptoms after a TBI, from those symptoms people are simply taking note of for the first time and attributing to their brain injury. For example, everyone forgets where they put their keys or what was discussed in an earlier conversation from time to time. But we don’t take much note of such occurrences because they are a relatively normal part of life. Someone who has a head injury will often start assigning each and every instance to their brain injury. Worrying about these symptoms, will make each instance seem worse. Luckily, with time, many of these symptoms will resolve themselves.
We will often task family members with noting their perceived changes in a recent head-injury victim to compare with the victim’s own self analysis. There are also objective ways to illustrate head injuries, such as MRIs and:
Neuro-Psychological Evaluations will put the patient through a battery of tests to obtain data related to their cognitive efficiency, processing speed, general intellectual functioning, motor skills, coordination, cognitive retreival/recall capabilities, verbal memory, visual memory, attention to visual detail /visuospacial skills, emotional functioning, reading/writing ability, language abilities, attention/concentration, abstract reasoning, problem solving skills, as well as others.
These tests can take many hours. Sometimes they will need to take course over a few days. The neuropsychological evaluator will also rely on historical data (prior academic achievement, employment, medical history, prior MRI or CT scans, relationships with others) to compare premorbid (prior to TBI) and postmorbid (after the head injury) functioning. These neuropsychological tests have built in lie detectors to ascertain when someone is trying to intentionally misrepresent their abilities.